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Zheng Y, Li C, Yang J, Seery S, Qi Y, Wang W, Zhang K, Shao C, Tang YD. Atherogenic index of plasma for non-diabetic, coronary artery disease patients after percutaneous coronary intervention: a prospective study of the long-term outcomes in China. Cardiovasc Diabetol 2022; 21:29. [PMID: 35193553 PMCID: PMC8864872 DOI: 10.1186/s12933-022-01459-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
Background Non-diabetic coronary artery disease (CAD) patients are thought to encounter metabolic dysfunction and while these changes may be imperceptible to the patient they probably influence outcomes. At present, there is no system to support patients sensing these subtle changes, nor is there an established model for prognoses. The Atherogenic Index of Plasma (AIP) index has already proven useful for atherosclerosis although further research is needed, especially for those without hyperglycemia. Methods This is a prospective study of 5538 non-diabetic CAD patients who had received percutaneous coronary intervention (PCI). Participants were assigned to one of three groups according to their AIP index. High AIP index cases were then compared to low index patients according to major adverse cardiac events (MACE). Restricted cubic spline (RCS) analysis was also conducted to investigate interrelations between AIP index levels and hazard ratios (HR) for MACEs. Results Patients with a high AIP index encountered metabolic dysfunction compared to those with a low AIP index i.e., higher Body Mass Index (BMI), Total Cholesterol (TC), Triglycerides (TG), and uric acid as well as lower HDL-C. Each of the aforementioned interrelations were significant with p values of less than 0.001. There was also a significant increase in the number of MACEs in the high AIP index group compared to the low AIP index group (HR: 1.37, 95% CI 1.04–1.81; p = 0.025). A J-shaped RCS curve highlighted a change in the HR after the 0.18 juncture (HR per SD: 1.20, 95% CI 0.96–1.50). Further subgroup analysis supported the main findings, all with HRs greater than one. Conclusion The AIP index could be used in prognostics for non-diabetic CAD patients 2 years after PCI. The relationship between hazard ratio and the AIP index appears to be J-shaped. Although, further multi-center studies designed for non-diabetic patients with potential metabolic dysfunction should be conducted to determine the value of the AIP index.
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Affiliation(s)
- Yitian Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, UK
| | - Yu Qi
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Wenyao Wang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Yi-Da Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China.
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Factors associated with poor prognosis in patients with atrial fibrillation: An emergency department perspective the EMERG-AF study. Am J Emerg Med 2021; 50:270-277. [PMID: 34418718 DOI: 10.1016/j.ajem.2021.07.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We sought to identify the factors associated with a worse prognosis in Emergency Department (ED) patients with atrial fibrillation (AF), crucial information to guide management decisions. METHODS This is a secondary analysis of a prospective, multicenter, observational cohort of consecutive AF patients attended in 62 EDs in Spain. Clinical variables were collected on enrollment. Follow-up was performed at 30 days and one year. The primary composite outcome was all-cause mortality, major bleeding and/or stroke at one year. Secondary outcomes were each of these components considered separately, plus one-year cardiovascular mortality and the composite outcome at 30 days. RESULTS We analyzed 1107 patients. The primary outcome occurred in 209 patients (18.9%), one-year all-cause mortality in 151 (13.6%), major bleeding in 47 (4.2%), and stroke in 31 (2.8%). Disability (HR 2.064, 95% CI 1.478-2.882), previous known AF (HR 1.829, 95% CI 1.096-3.051), long duration of the AF episode (HR 1.849, 95% CI 1.052-3.252) and renal failure (HR 2.073, 95% CI 1.433-2.999) were independently associated with the primary outcome, whereas anticoagulation at discharge was inversely associated (HR 0.576, 95% CI 0.415-0.801). Disability was associated with mortality, cardiovascular mortality, and the composite at 30 days, and renal failure with mortality and major bleeding. CONCLUSIONS Comorbidities like renal failure, long AF duration and disability were related to adverse outcomes and should be decisive to guide management decisions in ED patients with AF. Anticoagulation had a positive impact on prognosis and should be the mainstay of therapy in AF patients attended in ED.
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Ferreira-González I, Sánchez-Recalde Á, Abu-Assi E, Arias MÁ, Gallego P, Del Río I. Revista Española de Cardiología: annual report 2019. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:410-417. [PMID: 32291243 DOI: 10.1016/j.rec.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | | | | | | | - Iria Del Río
- Editorial Director, Revista Española de Cardiología
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Ferreira-González I, Sánchez-Recalde Á, Abu-Assi E, Arias MÁ, Gallego P, del Río I. Revista Española de Cardiología: anuario de 2019. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Mai L, Wu Y, Luo J, Liu X, Zhu H, Zheng H, Liang G, Zhang Y, Huang Y. A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation. BMJ Open 2019; 9:e031180. [PMID: 31530618 PMCID: PMC6756322 DOI: 10.1136/bmjopen-2019-031180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine the real-world patterns of oral anticoagulant (OAC) therapy in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) in Southern China undergoing percutaneous coronary intervention (PCI) and determine the clinical characteristics associated with OAC prescription. DESIGN A retrospective cohort study. SETTING This study was conducted in the Shunde Hospital, Southern Medical University and the second hospital of Zhaoqing, China, from January 2013 to 31 December 2018. PARTICIPANTS Patients were aged ≥18 years, hospitalised for ACS and received PCI treatment. OUTCOME MEASURES AF was diagnosed based on an ECG recording or a Holter monitor. Prescription of OACs and antiplatelets were determined from the discharge medication list. RESULTS A total of 3612 patients with ACS were included: 286 (7.9%) were diagnosed with AF, including 45 (1.2%) with paroxysmal AF, 227 (6.3%) with persistent/permanent AF and 14 (0.4%) with unclassified AF. Although 95.5% of patients with AF were at high risk (CHA2DS2-VASc score ≥2) of stroke, only 21.7% of them were discharged on OACs (10.5% received warfarin and 11.2% received non-vitamin K antagonist OACs). Patients with pre-admission use of OAC, a HAS-BLED score <3, with persistent/permanent AF were more likely to receive OAC treatment at discharge. CONCLUSION We found that approximately 8% of patients who underwent PCI during ACS hospitalisation also demonstrated AF. Anticoagulant therapy was greatly underused. Patients with paroxysmal AF and an increased risk of bleeding were less likely to receive anticoagulant treatment. Further efforts should be made to increase the adherence to guideline recommendations for OACs.
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Affiliation(s)
- Linlin Mai
- Department of Cardiology, Shunde Hospital, Southern Medical University (The first people's hospital of Shunde), Foshan, China
| | - Yu Wu
- Department of Cardiology, Shunde Hospital, Southern Medical University (The first people's hospital of Shunde), Foshan, China
| | - Jianjing Luo
- Department of Cardiology, Shunde Hospital, Southern Medical University (The first people's hospital of Shunde), Foshan, China
- Department of Cardiology, The Second Hospital of Zhaoqing, Zhaoqing, China
| | - Xinyue Liu
- Department of Cardiology, Shunde Hospital, Southern Medical University (The first people's hospital of Shunde), Foshan, China
| | - Hailan Zhu
- Department of Cardiology, Shunde Hospital, Southern Medical University (The first people's hospital of Shunde), Foshan, China
| | - Haoxiao Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University (The first people's hospital of Shunde), Foshan, China
| | - Guoquan Liang
- Department of Cardiology, The Second Hospital of Zhaoqing, Zhaoqing, China
| | - Yan Zhang
- Department of Cardiology, Shunde Hospital, Southern Medical University (The first people's hospital of Shunde), Foshan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University (The first people's hospital of Shunde), Foshan, China
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Li J, Liu X, Zheng S, Huang Y. Anticoagulación oral en pacientes con fibrilación auricular e insuficiencia renal terminal: ¿qué es lo más apropiado? Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mahmood M, Lip GY. Anticoagulación oral en pacientes con fibrilación auricular e insuficiencia renal terminal: ¿qué es lo más apropiado? Respuesta. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mahmood M, Lip GYH. Use of Oral Anticoagulation in Patients With Atrial Fibrillation and End-stage Renal Disease: What Is Needed Nowadays? Response. ACTA ACUST UNITED AC 2018; 72:97-98. [PMID: 30173947 DOI: 10.1016/j.rec.2018.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Mahmood
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Li J, Liu X, Zheng S, Huang Y. Use of Oral Anticoagulation for Patients With Atrial Fibrillation and End-stage Renal Disease: What Is Needed Nowadays? ACTA ACUST UNITED AC 2018; 72:96-97. [PMID: 30126663 DOI: 10.1016/j.rec.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Jun Li
- Department of Cardiology, Shunde Hospital (First People's Hospital of Shunde), Southern Medical University, Shunde District, Foshan, China
| | - Xinyue Liu
- Department of Cardiology, Shunde Hospital (First People's Hospital of Shunde), Southern Medical University, Shunde District, Foshan, China
| | - Sulin Zheng
- Department of Cardiology, Shunde Hospital (First People's Hospital of Shunde), Southern Medical University, Shunde District, Foshan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital (First People's Hospital of Shunde), Southern Medical University, Shunde District, Foshan, China.
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